St Luke’s Surgery

01483 510 030

Asthma Review Questionnaire

We have written to all our patients who suffer with asthma (according to our records) to allow us to determine who will benefit most from a formal asthma review with a Doctor or Practice Nurse.

We would ask you to please answer the questions given below. Please note that if a review is necessary it may effect medication provided for future

  • We recommend that regardless of how you answer the questions below, if you have not seen your Doctor in the last 3 years for an asthma review then you should make an appointment at your convenience to have this done.
  • If you smoke and would like free NHS advice with help giving up please ring the QUIT 51 STOP SMOKING SERVICE on 0800 622 6968 or text ‘smokefree’ to 66777
  • It is advisable that if you are a patient who uses a brown/preventer/steroid inhaler e.g. Clenil or Qvar, to have an annual flu jab. This can be given at your Asthmas review appointment unless you tick the box below. with the Practice Nurse or GP.
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